Education Resources

Suicide Prevention

How to recognize the warning signs of suicide and start difficult conversations about mental health.

Know what to look for.

Be aware of risk factors, protective factors, tipping points, and warning signs.

Risk factors indicate someone is at heightened risk for suicide, while protective factors indicate that a person is at reduced risk of suicide. Risk and protective factors may be present in both individuals and communities. Recognizing them will help you understand what might need to change within an individual or a community in order to decrease suicide risk over time.

Tipping points are sources of stress that may push an at-risk person to commit suicide, and warning signs are specific indications that a person is at immediate risk for suicide. Recognizing both will help you take action to help someone who needs help right now.

Risk Factors

Prior suicide attempt
Access to lethal means, especially firearms
• Depression, bipolar disorder, or schizophrenia
• Borderline or antisocial personality disorder
• Substance abuse disorders
• Family history of mental illness or suicide
• Family violence, including physical and sexual abuse
• Exposure to others’ suicidal behavior.
• Prolonged stress from bullying, bad relationships, or unemployment.

Protective Factors

• Connectedness to individuals, family, community, and social institutions
• Availability of physical and mental health care
• Problem-solving skills and coping ability
• Effective mental health care
• Contacts with caregivers

Tipping Points

• Negative events in a relationship (arguments, break-ups)
• Financial hardship
• Legal difficulties
• Public humiliation or shame
• Worsening medical prognosis
• Losing a job, opportunity, or dream
• Exposure to the death of a peer
• Other stressful events, like upcoming exams or receiving a poor grade on an important assignment

Warning Signs

Threatening to hurt or kill oneself.
Seeking the means to commit suicide.
Talking about a specific plan to commit suicide.
Preparing for death by organizing affairs and saying goodbyes.
• Feelings of hopelessness, worthlessness, self-loathing, guilt extreme sadness, or anxiety
• Changes in eating or sleep habits
• Increasing alcohol or drug use
• Dramatic mood changes
• Aggression, irritability, or recklessness



Adapted from Suicide Prevention Resource Center Risk and protective factors primer and Society for Prevention of Teen Suicide Suicide Warning Signs.


Be prepared to act.

Approaching a friend who you’re concerned about can seem like an overwhelming task. How do you start the conversation? What do you talk about? What shouldn’t you talk about? All of these are reasonable questions to ask, but don’t let them deter you from acting.

Express concern and compassion. Let your friend know you care, you are ready to listen, and that he/she is not alone. Don’t avoid the conversation because you’re worried about finding the right words. Offer hope. Reassure the person that help is available and that the suicidal feelings are temporary. Let the person know that his or her life is important to you.

Talking to someone close to you about his or her suicidal thoughts be extremely difficult, but if you’re unsure whether someone is suicidal, the best way to find out is to ask. You won’t make a person suicidal by showing that you care. In fact, giving a suicidal person the opportunity to express his or her feelings can provide relief from loneliness and pent-up negative feelings, and may prevent a suicide attempt.

Find a time where you can speak to your friend in private. Mention that you have been feeling concerned about that person. Gently introduce the changes in behavior that you’ve observed and explain why they trouble you. Here are some statements that might help you start a conversation about suicide:

• I have been feeling concerned about you lately.
• Recently, I have noticed some differences in you and wondered how you are doing.
• I wanted to check in with you because you haven’t seemed yourself lately.

Your words should convey compassion, care, and sincerity:

• “You aren’t alone in this. I care about you.”
• “I know you may not believe it now, but the way you’re feeling will change.”
• “I may not be able to understand exactly how you feel, but I care about you and want to help.”
• “When you want to give up, tell yourself you will hold off for just one more day, hour, minute—whatever you can manage.”

Encourage your friend to share his or her feelings with you. Be prepared to listen, and don’t be taken aback if your friend wants to vent emotions and frustration. You can ask questions to get your friend to open up, such as:

• “When did you begin feeling like this?”
• “Did something happen that made you start feeling this way?”
• “How can I best support you right now?”
• “Have you thought about getting help from (campus counseling, etc…)?”
• “Have you made a plan to commit suicide?” .

When a depressed person answers these questions, don’t be surprised if the conversation turns negative. Let them know that people sometimes feel like there is no answer, but that treatment can help them to feel better. Tell them you will support them while they find help. If someone has a plan for suicide, they are at very high risk. Look at the FAQ for more information.

• Avoid being argumentative, confrontational, or judgmental.
• Avoid statements like, “You have so much to live for,” or “Killing yourself will hurt your friends and family,” this is often counterproductive. Depression blinds the victim to those reasons to live, and mentioning the harm that suicide could do to others can worsen underlying feelings of guilt.
• Don’t try to fix problems you might perceive. Offering solutions and advice can make your friend feel like he or she is being lectured or needs to justify his or her feelings. You can’t fix depression. You can support your friend and encourage him or her to seek help.
• Don’t promise to keep a friend’s suicidal thoughts secret.

Adapted from the American Foundation for Suicide Prevention and helpguide.org


Frequently Asked Questions

1What should I do if someone tells me they have a plan to kill themselves?
If you know someone who is considering suicide, do not leave him or her alone. Remove any access he or she may have to firearms or other potential tools for suicide, including medications. Try to get this person to seek immediate help from his or her doctor or the nearest hospital emergency room. You can call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255. Take them to a doctor, mental health professional, or hospital emergency room for help.

Adapted from the NIMH Suicide FAQ.

2Will asking a person if they are suicidal or if they have a plan to kill themselves actually give that person the idea to commit suicide?
No. You are not making it more likely that your friend will commit suicide. When a friend starts displaying warning signs, ask that person if he or she is having thoughts of suicide. If so, follow up by asking if that person has a plan. By asking these questions, you are showing concern and letting your friend know that you take him or her seriously.

Adapted from the helpguide.org

3If somebody really wants to die, is there really anything anybody can do to stop that person?
Most depressed and suicidal people don’t want death. They want to end their pain and reassert control over their lives. They have mixed feelings about following through with suicide until the very last moment. Suicidal thoughts are usually due to an underlying mental illness, and those illnesses are treatable. By offering support and encouraging a suicidal person to get the help, you can help save a life.

Adapted from the American Foundation for Suicide Prevention and helpguide.org.

4What should I do if I think someone is suicidal, and that person refuses to get help?
Many people living with mental illness are put off by the thought of seeing a mental health professional. Initially, they may be overwhelmed, uncomfortable, or fearful of stigmatization. Over time, a depressed person might lose the motivation to seek treatment. As helplessness builds, that person may come to believe that he or she is un-fixable, and treatment is a waste of time. Sometimes suicide seems like the only way to end the pain.

If a friend has expressed suicidal thoughts but doesn’t want to seek treatment, continue to express your concern. Emphasize that mental health professionals understand what your friend is feeling, and they can help your friend feel better. Continue to let your friend know you are there to listen. Offer help finding or getting to a doctor, mental health professional, or hospital emergency room. You can also help by staying with them and calling the National Suicide Prevention Lifeline at 1-800-273-8255. If you are concerned that the your friend will hurt him or herself, call 911.

Adapted from the American Foundation for Suicide Prevention

5If a friend confides in me, but wants me to keep his or her thoughts of suicide secret, what should I do?
Do not make promises of secrecy. If you have already done so, there may come a time when you need to break that promise. While trust and respect of privacy are important in every relationship, your friend’s life is more important. Tell someone you trust about your friend and ask for their help in getting your friend to a mental health professional. Your friend may be angry. You may lose that friendship, at least for a time. However, saving a life is the highest priority.

Adapted from the American Foundation for Suicide Prevention

6Are cutting and other forms of self-harm the same as making a suicide attempt?
Self-harm (e.g. cutting) is typically not intended to be a suicide attempt. Many people who cut themselves never attempt to kill themselves. Most people who engage in self harm do so to cope with with despair, anger and frustration. It brings momentary relief, but is often followed by guilt, shame, and the return of the painful emotions that led to self-harm in the first place. People who engage in self-harm are at risk of increasingly serious and even deadly forms of self-injury. Self-harm is associated with a variety of mental disorders that are considered risk factors for suicide.

Regardless of whether someone who engages in self-harm expresses a desire to commit suicide, that person needs help. Professionals are trained to determine whether a person is at risk for suicide, and to suggest a treatment plan to help them with their self-harm behavior and underlying feelings.

Adapted from the American Foundation for Suicide Prevention and the Mayo Clinic.

7Is it true that a person who talks about suicide isn’t really serious?
Absolutely not. Most people who die by suicide express thoughts of suicide to someone else before they take their lives. If a friend talks about suicide, that person is giving you an opportunity to help before. Take all mentions of suicide seriously.

Adapted from the American Foundation for Suicide Prevention

8Can antidepressant medications make you suicidal?
An FDA review found that very rarely, a class of antidepressants called SSRI’s can increase the risk of suicidal thoughts or behavior in children and adolescents. However, there were no completed suicide attempts among the nearly 2200 patients taking SSRI’s in the study. A later 2007 study in the Journal of the American Medical Association suggested that the benefits of antidepressant medications likely outweigh their risks to children and adolescents with major depression and anxiety disorders.

If you or a friend is prescribed to one of these medications, it is because a doctor believes taking that medication is the best course of action for you. It is important to stay in close touch with your doctor, and to talk with her or him about all of the changes you feel and notice. Your doctor can change your medication or adjust your dosage to help you get the most benefit with the fewest side effects. Studies show that early treatment with antidepressant medication can stop symptoms of depression from becoming more severe and long-lasting. They can also reduce the risk of the depression coming back, and reduce the risk of suicide resulting from depression. No studies have found antidepressant use in any age group to be associated with completed suicide.

Adapted from the American Foundation for Suicide Prevention and the NIMH.

9Is someone who has had recent suicidal ideation or a recent suicide attempt still at risk for suicide, even if they're feeling better?
Treating depression or any other underlying mental illnesses reduces the long-term risk for suicide. However, it’s difficult to know where a suicidal person is in their recovery. Someone who has felt suicidal may work hard to hide his or her feelings, and may appear to be functioning well socially, professionally, or academically. In some cases, a person who has made the decision to die may seem calmer and at peace. Each year, suicide claims the lives of people who seemed happy, well-liked, and successful to his or her friends, families, and others around them. Staying in treatment after the suicidal thoughts and symptoms seem to be getting better is the best way to ensure a successful recovery. The decision to stop treatment should be made together by the mental health professional and patient.

Adapted from the American Foundation for Suicide Prevention